APPENDIX A1

To
The Principal
College of Nursing
Medical College and Hospital
Kolkata-73
Subject: Application for permission to conduct research study.
Respected Madam,

With due respect, I would like to say that I am Ishika Roy, an M.Sc. Nursing student(2018-2020) of
College of Nursing, Medical College & Hospital, Kolkata-73. I have selected a problem statement for
dissertation to be submitted to The West Bengal University of Health Sciences in the partial fulfillment
of the university requirement.

The topic selected for study is “Effect of oromotor stimulation on sucking and feeding
performance of preterm neonates admitted in neonatal intensive care units of selected hospital,
West Bengal."

Name of the Guide: Ms. Manasi Jana, Reader, College of Nursing, Medical College and Hospital.
Name of the Co-Guide: Ms. Rakhi Ghosh, Senior Faculty, College of Nursing, Medical College and
Hospital.

Setting:

For pilot study: R.G. Kar Medical College and Hospital, West Bengal.
For final study: Medical College and Hospital, West Bengal.

Period of Data collection:

For Pilot Study: 22.07.2019 to 03.08.2019

For Final Study: 16.10.2019 to 30.11.2019

I will bear all the expenses of the research project on my own and will have informed consent and
permission of all participants and concerned authorities before starting the study.

I shall be highly obliged if you kindly give me permission to conduct the proposed study.

Thanking You,

Yours sincerely,

Ishika Roy
M.Sc. Nursing Student
College of Nursing
Medical college & Hospital

134
APPENDIX A2

135
APPENDIX A3

136
APPENDIX A4

137
138
 APPENDIX A5

Government of West Bengal

Office of the Principal
Govt. College of Nursing
Medical College & Hospital, Kolkata-700073,W.B
Phone No. 033-22551600 / 22123870 FAX – 033-22123806 E-mail: – medcon15kolkata@gmail.com
Memo No – HCN/CON/MCH/ Date:-

To,
The MSVP
Medical College and Hospital
Kolkata-700049

Subject: Seeking permission for conducting a research study by M.Sc. Nursing student of
College of Nursing, Medical College and Hospital, Kolkata.

Respected Sir/ Madam,

This is to introduce Ishika Roy, M.Sc. Nursing student (2018-2020) of

College of Nursing, Medical College and Hospital, Kolkata-73. She has to conduct a study for
dissertation to be submitted to The West Bengal University of Health Sciences for the partial
fulfillment of M.Sc. Nursing degree under The West Bengal University of Health Sciences.

The title of the research study is “Effect of oromotor stimulation on sucking and feeding
performance of preterm neonates admitted in neonatal care unit of selected hospital,
West Bengal.”
The student is in need of your permission to conduct her final study at your institution on and
from 6.10.2019-30.11.2019.

Therefore I am requesting you to kindly extend your cooperation and grant the permission to
enable her to work on the proposed study.

Your cooperation will be solicited

Thanking You,

Yours sincerely

Prof. Dr.Smritikana Mani

Principal
College of Nursing
Medical college & Hospital
Kolkata-73

139
To,
The MSVP
Medical College and Hospital
Kolkata-700073

(Through Proper Channel)

Subject: Seeking permission for conducting a research study by M.Sc. Nursing student of
College of Nursing, Medical College and Hospital, Kolkata.

Respected Sir/ Madam,

With due respect I wish to state that I am Ishika Roy, an M.Sc. Nursing student (2018-2020)
of College of Nursing, Medical College & Hospital, Kolkata-73. I have selected a problem
statement for dissertation to be submitted to The West Bengal University of Health Sciences
for the partial fulfillment of the university requirement.

The topic selected for study is: “Effect of oromotor stimulation on sucking and feeding
performance of preterm neonates admitted in neonatal care unit of selected hospital, West
Bengal.”

In this connection I need your necessary permission on all sorts of cooperation in conducting
my final study from.

I will be highly obliged if you give me the permission to conduct the final study.

Thanking You,

Yours sincerely,

Ishika Roy
M.Sc. Nursing Student
College of Nursing,
Medical College & Hospital
Kolkata-73

140
APPENDIX B1

141
APPENDIX B2

142
143
APPENDIX B3

144
145
APPENDIX B4

146
APPENDIX B5

147
148
 APPENDIX C1

Letter for opinion and suggestion from Expert

Date:

To

__________________________________________

___________________________________________
Subject: Requesting for opinion and suggestion from expert for content validity of data
collection tools.
Respected Sir/Madam
With great honor I would like to inform you that I am Ishika Roy, M.Sc. Nursing first year student
of College of Nursing, Medical College and Hospital, Kolkata. According to the curriculum I have
to submit a research project to the WBUHS. The problem statement of my research study is “Effect
of oromotor stimulation on sucking and feeding performance of pre term infants admitted
in neonatal care unit of selected hospital, West Bengal.”
As a part of the project, I have developed following tools hereby I am enclosing the following:
1. Problem statement and objectives
2. Tool- I ( record analysis proforma)
3. Tool- II ( Non – Nutritive sucking scoring scale )
4. Tool-III (Early Feeding Performance scale)
5. Criteria checklist for Tool 1,2 and 3
6. Certificate of validation

I request you to kindly go through the content of the tool and give your valuable opinion and
suggestions in terms of relevancy, adequacy, objective fulfilment and appropriateness of the
tools. Your valuable suggestions and kind co-operation will be highly incorporated in my study.

Thanking you in anticipation for your favourable consideration.

Yours faithfully

Ishika Roy
M.Sc. Nursing First year student
College of Nursing, Medical College and Hospital
Kolkata
Phone no.- 7278804830

149
 APPENDIX C2

CRITERIA CHECKLIST FOR VALIDATION of TOOL I (Record analysis proforma)

Introduction:
The validator is requested to go through the structured interview schedule to obtain the
sociodemographic profile and others disease related general information and give
valuable response in terms of relevancy,adequacy, objective fulfilment and
appropriateness of each questions introduced and kindly place a tick () against each
item in appropriate response column.

Column 1: Agree
Column 2: Disagree

Tool I
Record analysis proforma

Items Relevant Adequate Objective Appropriate Remarks

fulfilment
1 2 1 2 1 2 1 2
I

II

III

IV

150
 APPENDIX C3

CRITERIA CHECKLIST FOR VALIDATION TOOL II

TOOL II: -

Non-Nutritive Sucking Scoring Scale

Adapted from Neiva FCB, Leone CR, Leone C

Items Relevant Adequate Objective fulfilment Appropriate Remarks

1 2 1 2 1 2 1 2
I. A

I. B

I. C

I. D

I. E

I. F

I. G

I. H

I. I

II. A

II. B

II. C

151
APPENDIX C4

152
 APPENDIX C5

CERTIFICATE OF VALIDATION

This is to certify that the content and tool construction of Mrs. Ishika Roy, M.Sc(N) from
College of Nursing ,Medical College and Hospital ,Kolkata to be used her research study
“Effect of oromotor stimulation on sucking and feeding performance of pre term
infants admitted in neonatal care unit of selected hospital, West Bengal” has been
validated by me.

Signature

Name:

Description:

Date:

Seal:

153
 APPENDIX C6

Serial Name of experts Designation

no.
Senior Lecturer
1. Dr. Alpanamayi Bera W.B Govt. College of Nursing
S.S.K.M Hospital

Associate Professor
2. Smt. Kaberi Das College of Nursing
Asia Heart Foundation

Vice Principal
3. Smt. Panchali Pal Peerless College of Nursing

Associate Professor
4. Dr. Dinesh Munian SNCU in Charge
Medical College & Hospital
Kolkata
Associate Professor
5. Smt. Piyali De College of Nursing
Asia Heart Foundation

Clinical Instructor
6. Smt. Madhuri Nandi College of Nursing
R.G Kar Medical College &
Hospital
Clinical Instructor
7. Smt. Supa Guha W.B Govt. College of Nursing
S.S.K.M Hospital

154
 APPENDIX D1

Informed Consent Form

I have been properly explained by the researcher about the purpose and method of this
research study. I know that it is a study to assess the effect of oromotor stimulation on
sucking and feeding performance of preterm neonates admitted in neonatal care unit of
selected hospitals of West Bengal. I have also informed that the researcher is a student of
M.Sc. Nursing of College of Nursing, Medical College and Hospital.
The researcher will provide 10 minutes pre-feeding oral stimulation program twice daily
at two consecutive feeding for three consecutive days to my child. The program included
two forms of oral stimulation: manual peri- oral and intraoral stimulation. After finishing
oral stimulation, at second feeding the research investigator will feed my baby by katori
spoon if my baby is able, he will receive katori spoon feeding (expressed breast milk)
orally and if my baby is some able or unable he will continue feeding by gavage.
I have understood that the study will cause no harm to my child and I can withdraw my
child’s participation from the study whenever I wish. Researcher can take any decision
regarding my child’s participation in the study at any time. I can contact the researcher
any time regarding any question.
My child’s participation in this study is purely voluntary. I will not be given any incentive
for my child participation in this study. After agreeing to give full consent for participation
of my child I shall fully cooperate with the researcher for achievement of the objectives
of the study.

Signature of parents Signature of researcher

Date:-

155
 APPENDIX – D2

গেবষণায় অংশ হেণর স িত প

গেবষক আমােক এই গেবষণার উে শ এবং প িত স ঠক ভােব ব াখ া কেরেছন। আিম জািন য এ ট

প মবে র িনবািচত হাসপাতাল িলর নবজাতক য ইউিনেট ভিত াক- ময়াদী নবজাতেকর খাদ
হেণর মতার উপর ওেরােমাটার উ ীপনার ভােবর মূল ায়ন করার এক ট গেবষণা। আিম এও
জািন গেবষক কেলজ অফ নািসং, মিডেকল কেলজ এবং হাসপাতােলর াতক র িবভােগর ছা ী।

গেবষক িতন িদন ধের িতিদন িদেন দুবার দুধ খাওয়ােনার আেগ আমার স ানেক ১০ িমিনেটর মৗিখক
উ ীপনা দান করেবন। মুেখর িভতের এবং বাইের এই উ ীপনা দওয়া হেব। মৗিখক উ ীপনা শষ
করার পর, গেবষক বা ট চামচ িদেয় আমার বা ােক দুধ খাওয়ােনার চ া করেবন। যিদ আমার বা া
বা ট চামচ িদেয় দুধ খেত পাের তাহেল তােক এরপর থেক বা ট চামচ িদেয় মুেখ খাওয়ােনা হেব আর
যিদ আমার বা া ঠক মত মুেখ খেত স ম না হয় তেব তােক নেলর সাহােয ই দুধ খাওয়ােনা হেব।

আিম বুঝেত পেরিছ য এই অধ য়ন আমার স ােনর কান িত করেব না। গেবষণা র পেরও
আিম ই া অনুযায়ী য কােনা সময় আমার স ানেক অধ য়ন থেক ত াহার করেত পাির এবং
গেবষকও য কান সময় গেবষণায় আমার স ােনর অংশ হণ স েক য কােনা িস া িনেত
পােরন। এই গেবষণায় আমার স ােনর অংশ হেণর জন আমােক কান সুিবধা দওয়া হেব না।
গেবষক এই গেবষণার ফলাফল স েক আমােক অবিহত করেবন এবং আিমও য কান সময় এই
গেবষণা স িকত য কান ে র জন গেবষেকর সােথ যাগােযাগ করেত পাির।

আিম স ূণ ভােব িনেজর ই ােত আমার স ােনর এই গেবষণায় অংশ হেণ স ূণ স িত িদ ।

এই গেবষণায় আমার স ােনর অংশ হেণ স ত হওয়ার পের আিম গেবষণায় সুিবধার জন গেবষেকর
সােথ স ূণ সহেযািগতা করব।

িশ র িপতা বা মাতার সা র গেবষেকর সা র

তািরখঃ-

156
 APPENDIX – D3
अ यन म भाग लेने के िलए सहमित प

शोधकता ने मुझे इस अ यन के उ े और िविध को सही तरीके से समझाया। मुझे पता है िक यह पि म

बं गाल म चयिनत अ तालों की neonatal care units म भत ी-टम नवजात िशशु ओं की मुंह से भोजन ले ने
की मता पर अरोमोटर उ ेजना के भाव का मू ां कन करने के िलए एक अ यन है । मुझे यह भी पता है
िक शोधकता निसग कॉलेज, मेिडकल कॉले ज और अ ताल का ातको र छा है ।

शोधकता मेरे ब े को तीन िदन तक दो दू ध िपलाने से पहले 5 िमनट की मौ खक उ ेजना दे गा। यह उ ेजना
मुंह के अं दर और बाहर दी जाएगी। मौ खक उ ेजना के पू रा होने के बाद, शोधकता मेरे ब े को च च से दू ध
िपलाने की कोिशश करे गा। अगर मेरा ब ा च च से दू ध खा सकते ह तो तब से इसे च च के साथ खलाया
जाएगा और अगर मेरा ब ा ठीक से खाने म स म नही ं है , तो उसे ूब की मदद से दू ध िपलाया जाएगा।

मुझे पता है िक इस अ यन से मेरे ब े को कोई नु कसान नही ं होगा। म अ यन शु होने के बाद िकसी भी
समय अपने ब े को अ यन से हटा सकता ं , और शोधकता िकसी भी समय अ यन म मेरे ब े की
भागीदारी के बारे म कोई भी िनणय ले सकता है । इस अ यन म मेरे ब े की भागीदारी से कोई लाभ नही ं
होगा। शोधकता मुझे इस अ यन के प रणामों के बारे म सूिचत करे गा और म इस शोध से संबंिधत िकसी भी
के िलए िकसी भी समय शोधकता से संपक कर सकता ं ।

म अपनी इ ा से इस अ यन म अपने ब े की भागीदारी के िलए पू री तरह से सहमत ं । अपने ब े के इस

अध्ययन म भाग ले ने के िलए सहमत होने के बाद, म अ यन की सुिवधा के िलए शोधकता के साथ पूरा सहयोग
क ं गा।

ब े के माता-िपता के ह ा र शोधकता के ह ा रह

िदन

_________________________________________

157
APPENDIX – E

158
 APPENDIX – F1

TOOL I

RECORD ANALYSIS PROFORMA

Code no:- _________________________

I.Age in Day

i. 0-3 days:-

ii. 4-7 days:-

II. Gender

i. Boy

ii. Girl

III. Gestational Age (in week):-

i. 27weeks – 29weeks:-

ii. 30weeks – 32weeks:-

IV. Birth Weight (in grams)

i. 1000grams - 1199grams:-

ii. 1200grams – 1399grams:-

iii. 1400grams – 1599 grams:-

V. Type of Feeding

i. Expressed Breast Milk

ii. Artificial feeding

159
 APPENDIX – F2

TOOL II :- Non-Nutritive Sucking Scoring Scale

Positive Items:- Pretest Day 1 Day 2 Day 3

(before (before (before
feeding) feeding) feeding)
1st feed 2nd feed 1st feed 2nd feed 1st feed 2nd feed
I.A Rooting reaction:
a) Yes (4)
b) No (0)
I.B Easy Beginning of
Sucking:
a) Yes (4)
b) No (0)
I.C Labial Sealing:
a) Always(12)
b) Most part (8)
c) Sometimes (4)
d) Never (0)
I.D Tounge Central Groove:
a) Always(9)
b) Most part (6)
c) Sometimes (3)
d) Never (0)

I.E Peristaltic Tounge

Movements:
a) Always(9)
b) Most part (6)
c) Sometimes (3)
d) Never (0)

I.F Jaw Raising and

Lowering Movements:
a) Always(9)
b) Most part (6)
c) Sometimes (3)
d) Never (0)

I.G Labial, Tounge and Jaw

Coordination:
a) Always(15)
b) Most part (10)
c) Sometimes (5)
d) Never (0)

160
 I.H Sucking strength:
a) Always(12)
b) Most part (8)
c) Sometimes (4)
d) Never (0)

I.I Sucking Rhythm:

a) Always(12)
b) Most part (8)
c) Sometimes (4)
d) Never (0)

Negative items:-
II.A Bites:
a) Always(-3)
b) Most part (-2)
c) Sometimes (-1)
d) Never (0)
II.B Excessive jaw
excursion:
a) Always(-3)
b) Most part (-2)
c) Sometimes (-1)
d) Never (0)
II.C Stress signals:-
a) Always(-15)
b) Most part (-10)
c) Sometimes (-5)
d) Never (0)

Score:-
a) >50 = Good sucking performance
b) 33-49 = Moderate sucking performance
c) <33 = Poor sucking Performance

161
 APPENDIX – F3

TOOL III :- Early feeding performance scale

Items :- Pretest Day 1 Day 2 Day 3

1st feed 2nd feed 1st feed 2nd feed 1st feed 2nd feed
I. Oral feeding readiness:-
A. Able to hold body in a
flexed position with
arms/hands toward midline:
i. Yes
ii. No
B. Baby is active during
assessment period
i. yes
ii. No
II. Oral feeding skill
A. Ability to remain engaged in feeding:
A1. Predominant muscle tone:
i. Well Flexed, good
muscle tone.
ii. Not well flexed,
hypotonic.
iii. No tone felt;
flaccid
A2. Predominant state during
the feeding
i. Quite alert
ii. Drowsy
iii. Sleep
iv. Fuss / Cry
Ability to Organize Oral – Motor Functioning:

B1. Opens mouth promptly

when lips are stroked at
feeding onset:
i. Always
ii. Most of the time
iii. Sometimes
iv. Never

B2. Tongue descends to

receive feed at feeding onset:
i. Always
ii. Most of the time
iii. Sometimes
iv. Never

162
B3. Once feeding is under
way, Maintains a smooth,
rhythmic pattern of sucking:
i. Always
ii. Most of the time
iii. Sometimes
iv. Never

C. Ability to coordinate swallowing:

C1. Manage milk during
feeding (ie. No spillage :-)
i. No loss of milk
ii. Some loss of milk
iii. Frequent loss of
milk

C2. Recommended amount of

milk taken:-
i. >90%
ii. 75% - 90%
iii. 50% - 74%
iv. <50%
C3. Quite swallow- no heard
swallow
i. Quite swallows
ii. Some heard
swallows
iii. Frequent heard
swallows
iv. No significant no.
of swallow
C4. Coughing or choking:
i. No event observed
ii. At least one event
observed.

D. Ability to maintain Physiologic Stability

D1. After feeding onset any

behavioral stress cues (crying,
eyebrow raise, worried look,
movement away from paladi):
i. Never
ii. Occasional
iii. Frequent
D2. Clear breath sounds – (no
grunting breath sounds):
i. No grunting
ii. Sometimes
grunting
iii. Frequent granting

163
D3. Clear breath sounds – (no
stridor breath sounds):
i. No stridor
ii. Sometimes stridor
iii. Frequent stridor

D4. Nasal flaring :-

i. No nasal flaring
ii. Occasional nasal
flaring
iii. Frequent nasal
flaring
D5. Colour change during
feeding:- (pallor and cyanosis)
i. Never
ii. Occasional colour
change
iii. Frequent or colour
change

III. Oral Feeding Recovery (During the First Five Minutes Post-feeding)

A. Predominant state:
i. Quite alert
ii. Drowsy
iii. Sleep
iv. Fuss / Cry

B. Predominant muscle
tone:
i. Well Flexed, good
muscle tone.
ii. Not well flexed,
hypotonic.
iii. No tone felt;
flaccid

164
 APPENDIX – H1

List of codes for Tool I (Record analysis proforma)

ITEMS CODE NO.

i. 0 – 3 days 1
I. Age in day
ii. 4 – 7 days 2

i. Boy 1
II. Gender
ii. Girl 2

i. 27 weeks – 29 weeks 1
III. Gestational age
ii. 30 weeks – 32 weeks 2

i. 1000 grams – 1199 grams 1

IV. Birth weight

ii. 1200 grams – 1399 grams 2

iii. 1400 grams – 1599 grams 3

i. Expressed breast milk 1

V. Type of feeding
ii. Artificial feeding 2

166
 APPENDIX – H2

Master data sheet on Record analysis proforma of experimental group

167
 APPENDIX – H3

Master Data sheet on Sucking performance of Experimental group as measured by Non-nutritive sucking scoring scale

Sucking performance of Experimental group during Pre-test

168
Sucking performance of Experimental group in Day 1 during 1st Feed

169
Sucking performance of Experimental group in Day 1 during 2nd Feed

170
Sucking performance of Experimental group in Day 2 during 1st Feed

171
Sucking performance of Experimental group in Day 2 during 2nd Feed

172
Sucking performance of Experimental group in Day 3 during 1st Feed

173
Sucking performance of Experimental group in Day 3 during 2nd Feed

174
 APPENDIX – H4
Master Data sheet on feeding performance of Experimental group as measured by Early feeding performance scale

Feeding performance of Experimental group during Pre-test

175
Feeding performance of Experimental group in Day 1 during 1st Feed

176
Feeding performance of Experimental group in Day 1 during 2nd Feed

177
Feeding performance of Experimental group in Day 2 during 1st Feed

178
Feeding performance of Experimental group in Day 2 during 2nd Feed

179
Feeding performance of Experimental group in Day 3 during 1st Feed

180
Feeding performance of Experimental group in Day 3 during 2nd Feed

181
 APPENDIX – H5

Master data sheet on Record analysis proforma of control group

182
 APPENDIX – H6
Master Data sheet on Sucking performance of Control group as measured by Non-nutritive sucking scoring scale

Sucking performance of Control group during Pre-test

183
Sucking performance of Control group in Day 1 during 1st Feed

184
Sucking performance of Control group in Day 1 during 2nd Feed

185
Sucking performance of Control group in Day 2 during 1st Feed

186
Sucking performance of Control group in Day 2 during 2nd Feed

187
Sucking performance of Control group in Day 3 during 1st Feed

188
Sucking performance of Control group in Day 3 during 2nd Feed

189
 APPENDIX – H7

Master Data sheet on feeding performance of Control group as measured by Early feeding performance scale

Feeding performance of Control group during Pre-test

190
Feeding performance of Control group in Day 1 during 1st Feed

191
Feeding performance of Control group in Day 1 during 2nd Feed

192
Feeding performance of Control group in Day 2 during 1st Feed

193
Feeding performance of Control group in Day 2 during 2nd Feed

194
Feeding performance of Control group in Day 3 during 1st Feed

195
Feeding performance of Control group in Day 3 during 2nd Feed

196